Sisters Saving Sisters
Sisters Saving Sisters is a 5-module curriculum designed to empower young, teenage women to change their behavior in ways that will reduce their risk of becoming infected with HIV and other STDs, and significantly decrease their chances of being involved in unintended pregnancies. This curriculum acknowledges that abstinence is the most effective way to eliminate these risks, but also encourages the practice of safer sex and condom use.
| Category | Program Features |
|---|---|
| Setting | School / Community based |
|
Program Length |
5 hours/year | 1 year 5 sessions total |
| Age Group | Ages 12–18 |
| Look Inside |
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Overview | Description | Population | Authors
Overview
Sisters Saving Sisters is a 5-module curriculum designed to empower young, teenage women to change their behavior in ways that will reduce their risk of becoming infected with HIV and other STDs, and significantly decrease their chances of being involved in unintended pregnancies.
Description
This curriculum acknowledges that abstinence is the most effective way to eliminate these risks, but also encourages the practice of safer sex and condom use. The curriculum includes a series of fun and interactive learning experiences designed to increase participation and help young teenage women understand the kind of faulty reasoning and decision-making that can lead to HIV, other STDs and unintended pregnancy.
Activities are designed to address the underlying attitudes and beliefs that many young women have about condoms, make them feel comfortable practicing condom use, address their concerns about the negative effects of practicing safer sex, and build their condom-use skills as well as their ability to comfortably negotiate safer-sex practices. The activities involve viewing culturally and gender-sensitive video clips, playing games, brainstorming, role-playing, engaging in skill-building exercises, and small-group discussions that are designed to build group cohesion and enhance the learning experience. Each activity is brief, and most are active exercises that require the participants to interact with one another. This maintains their interest and attention in a way that lectures or lengthy group discussions do not.
At the completion of the Sisters Saving Sisters curriculum, young women will have:
- Increased knowledge about the prevention of HIV, other STDs and pregnancy
- More positive attitudes/beliefs about condom use
- Increased confidence in their ability to negotiate safer sex and to use condoms correctly
- Increased negotiation skills
- Improved condom skills
- Stronger intentions to use condoms if they have sex
- A lower incidence of HIV/STD risk-associated sexual behavior
- A stronger sense of pride and responsibility in making a difference in their lives
Program modules include:
- Module 1: Introduction and Overview
- Module 2: Understanding Personal Vulnerability
- Module 3: Developing Condom Use Skills
- Module 4: Improving Sexual Choices and Negotiation Skills
- Module 5: Role-Play, AIDS Basketball, and Review
Population Served & Setting
The curriculum was designed to be used with small groups of adolescent women ranging from 2 to 6 participants, but can be implemented with larger numbers as well if more time is built into each session. It is appropriate for various community settings, including schools and youth agencies.
About the Authors
Loretta Sweet Jemmott, PhD, RN, FAAN, is one of the nation’s foremost researchers in the field of HIV/AIDS, STD and pregnancy prevention, with a consistent track record of developing evidence-based sexual risk-reduction interventions. As an expert in health promotion research, she has led the nation in understanding the psychological determinants for reducing risk-related behaviors and how best to facilitate and promote positive changes in health behaviors. Her research is devoted to designing and evaluating theory-driven, culturally competent sexual risk-reduction behavioral interventions with various populations across the globe.
An outstanding translational researcher, Dr. Jemmott’s work has had global impact and changed public policy. She has partnered with community-based organizations, including churches, clinics, barbershops and schools, and transformed her NIH-funded evidence-based research outcomes for use in real-world settings. She has presented her research to the U.S. Congress and at the NIH Consensus Development Conference on Interventions to Reduce HIV Risk Behaviors. Dr. Jemmott has received numerous awards for her significant contributions to the field of HIV/STD and pregnancy prevention research, including the U.S. Congressional Merit Award, Sigma Theta Tau National Honor Society’s Episteme Award and Hall of Fame Award, and election to membership in the Institute of Medicine, an honor accorded to very few nurses.
John B. Jemmott III, PhD, received his PhD in psychology from the Department of Psychology and Social Relations at Harvard University. He holds joint faculty appointments at the University of Pennsylvania as the Kenneth B. Clark Professor of Communication in the Annenberg School for Communication, and as Professor of Communication in Psychiatry in the Perelman School of Medicine. He is also the director of the Center for Health Behavior and Communication Research at the Annenberg School for Communication.
Dr. Jemmott is a Fellow of the Association of Psychological Science, the American Psychological Association and the Society for Behavioral Medicine. He has published more than 100 articles and book chapters, and has received numerous grants from the National Institutes of Health to conduct research designed to develop and test theory-based, contextually appropriate HIV/STD risk-reduction interventions for a variety of populations in the United States and sub-Saharan Africa.
Konstance A. McCaffree, PhD, CSE is a certified sexuality educator and adjunct professor in the Center for Education Human Sexuality Program at Widener University in Chester, Pennsylvania. As a classroom teacher in the public schools, she has taught human sexuality to both elementary and secondary students for over 35 years. Her professional association work includes serving on the Board of Directors of the Sexuality Information and Education Council of the U.S. (SIECUS), as President of the Society for the Scientific Study of Sexuality (SSSS) and as an officer in the American Association of Sexuality Education, Counselors and Therapists (AASECT). She conducts workshops nationwide to help educators improve their skills in teaching sexuality education. She also conducts programs for parents, churches and community organizations to enhance their knowledge and skills in dealing with the sexuality of children and teenagers.
In recent years, Dr. McCaffree has developed curricula and implemented training programs for educators and other health professionals in South Africa, Zambia, Nigeria and the Philippines. For the past 10 years she has trained teachers and professors to implement a curriculum she developed in coordination with local educators throughout the country of Nigeria. She has used her expertise to develop training for curricula to prevent HIV/AIDS, unplanned pregnancy, and other health and social issues among children, teenagers and adults.
Length | Elements | Staffing | Notification
Length of Program
The curriculum has 5 hours of content divided into five 60-minute modules.
Program Elements
Core intervention materials include:
- Facilitator Curriculum
- Activity Set (handouts, posters, cards)
- Curriculum DVDs
- Nicole's Choice
- The Hard Way
- The Subject Is: HIV (Safer Sex Version)
- The Subject Is: STDs (Safer Sex Version)
- Wrap It Up & Condom Use Animation
The Sisters Saving Sisters implementation set includes the facilitator's guide, activity set and 5 DVDs. The curriculum requires the use of a monitor with DVD capabilities.
Staffing Requirements
This curriculum is designed to be taught by classroom teachers or family life educators. Educators interested in implementing this program should be skilled in using interactive teaching methods and guiding group discussions, and should be comfortable with the program content.
Parent/Guardian Notification
It is essential to inform parents and guardians regarding the nature and scheduling of this or any sexual health education program. Prior to implementation of the curriculum, families should receive written notice describing the goals of Sisters Saving Sisters and the nature of the content to be covered. Parents also should be given an opportunity to view the curriculum and related materials if they wish. The vast majority of parents want their children to receive appropriate instruction and be given the information and skills they need to protect their sexual health, but parents/guardians also must be allowed the chance to opt out or exclude their children from participating in the program, if they wish.
Logic Model | Evidence Summary | Reference
Logic Model
The program logic model can be found here:
Logic Model (pdf)
Evidence Summary
Research Design
The study tested the effects of HIV/STD risk-reduction interventions on unprotected sexual intercourse and the rate of STDs among African-American and Latino female patients in a low-income, inner-city adolescent medicine clinic that provided confidential and free family planning services. Participants were randomly assigned to 1 of 3 interventions based on cognitive behavioral theories and formative research. An information-based HIV/STD intervention provided information needed to reduce sexual risk, but it provided no practice or direct experience with condoms or roleplaying. A skill-based HIV/STD intervention provided information and taught skills necessary to practice and negotiate condom use. A health-promotion control intervention concerned health issues unrelated to sexual behavior.
The participants were 682 sexually experienced African American (n = 463) and Latino (n = 219) adolescent girls, 12 to 19 years of age (mean age, 15.5 years) who were family planning patients at the adolescent medicine clinic in a children's hospital serving a low-income, inner-city community in Philadelphia, Pa. Of the Latinos, 92.7% were Puerto Rican. The participants had volunteered for the “Women's Health Project” designed to reduce the chances that African American and Latino adolescent girls would develop devastating health problems, including cardiovascular diseases, cancer, and AIDS.
Data Gathering
The adolescents completed confidential self-administered questionnaires preintervention, immediately after the intervention, and at the 3-, 6-, and 12-month follow-ups. Preintervention and follow-up questionnaires assessed sexual behavior, demographic variables, and conceptual mediator variables. The postintervention questionnaire included conceptual mediator variables and evaluations of the interventions. Biological specimens for STD testing were collected at baseline and at the 6- and 12-month follow-ups.
To increase the validity of self-reported sexual behavior and reduce potential memory problems, the participants were asked to report their behaviors over a brief period (ie, 3 months), and received calendars clearly highlighting the period. To reduce the likelihood of demand from giving their responses to the intervention facilitators, proctors blind to the participants’ intervention assignment collected the questionnaire data. The proctors emphasized to participants the importance of responding honestly and assured them that their responses were confidential. Participants signed an agreement pledging to answer the questions honestly.
Findings
At baseline, 87.1% of the respondents reported having sexual intercourse in the previous 3 months. About 52.0% of the respondents had unprotected sexual intercourse in the previous 3 months; 15.8% had sexual intercourse with multiple partners in the previous 3 months; 9.5% had a least 1 child; and 21.6% tested positive for N gonorrhoeae, C trachomatis or T vaginalis. Few respondents (0.4%) reported having same-gender sexual relationships or using injection drugs (0.6%). About 97.6% of the adolescents attended at least 1 follow-up: 94.3% attended the 3-month follow-up; 92.8% attended the 6-month follow-up; and 88.6% attended the 12-month follow-up. The intervention conditions did not differ significantly in the percentage of adolescent participants who attended at least 1 follow-up, 2 follow-ups, or all 3 follow-ups. About 87.8% returned for the 6-month STD examination, and 82.3% returned for the 12-month STD examination. The interventions did not differ significantly in the percentage of adolescents who returned for STD examinations.
No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants or health control-intervention participants. At the 12-month follow-up, skills-intervention participants reported fewer sexual partners compared with health control-intervention participants, and were less likely to test positive for STD than were health control-intervention participants. No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants.
The results suggest that behavioral interventions, particularly those that focus on skills training, may be helpful in reducing unprotected intercourse and STD rate among adolescent girls. This is particularly important for African American and Latino adolescents, whose rate of STDs is considerably higher than the rate among other adolescents. The skills intervention also reduced self-reports of multiple of sexual partners at the 12-month follow-up compared with the health-promotion control intervention. Both unprotected intercourse and multiple sexual partners are important risk factors for STD.
Reference
General Adaptation Guidance | Pre/Post Tests | Policy
Adaptation Guidance
ETR is a leader in developing adaptation guidelines to enable professionals to adapt evidence-based intervention programs for implementation in underserved communities, while maintaining fidelity to the intervention's core components. ETR works with program developers to ensure that these tools are of the highest quality and meet the different needs of the field and end users, e.g., teachers, trainers, program mangers/staff, research teams, and funders.
See ETR’s General Adaptation Guidance
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
Pre/Post Tests
Classroom teachers can use pre/post tests to examine whether short-term knowledge learning objectives have been met. A simple pretest-posttest assessment design can be used to measure pre-instruction levels and post-instruction changes in student learning. The sample pre-test provided here is from the research study and gathers demographic data on participants in addition to assessing attitudes and sexual health knowledge.
Your ability to detect student change using this survey may vary and can be affected by numerous factors (e.g., number and content of lessons students receive, student scores at pretest, student motivation and interest in topic and survey, etc.) Improvement between pretest and posttest can be viewed as supportive, but not definitive, evidence of the curriculum's impact on short-term knowledge learning objectives. A well-designed evaluation study (e.g., using a strong experimental design with a well-matched comparison group and adequate sample size) with more extensive measurement would be needed to provide stronger evidence of curriculum impact.
Sisters Saving Sisters Pre- and Post-Questionnaire (pdf)
Learn more about how ETR can help with your evaluation needs >>
Training & TA
For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.
Training
Educators interested in implementing Sisters Saving Sisters should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach Sisters Saving Sisters receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on Sisters Saving Sisters is available through ETR's Professional Learning Services.
Technical assistance (TA), coaching and ongoing support
ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.
Enrichment Training
To support a holistic approach to teen pregnancy and HIV prevention programs, ETR offers a number of additional training and technical assistance opportunities, including content-specific workshops, skill-based trainings, organizational development consultation and much more. To learn more about these opportunities, visit our Training & TA pages >>
Adaptation
Adaptation support materials, training and/or TA are available to assist educators in meeting the needs of individual communities by implementing EBPs effectively and consistently with core components. All adaptation support is based on ETR's groundbreaking, widely disseminated adaptation guidelines and kits for effective adaptations.
Evaluation
ETR also provides evaluation support for EBP implementation. ETR uses well-established tools for measuring fidelity and outcomes. ETR's evaluation support blends participatory approaches with cutting-edge evaluation science. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.